Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia

The Interplay Between Diabetes and Oral Health: A Comprehensive Bibliometric Analysis of Clinical Trials (1967-2024)

Recognizing the complex interaction between diabetes and oral health is crucial, considering the increasing worldwide prevalence of these conditions. This bibliometric analysis delves into the extensive body of literature concerning the impact of diabetes on oral health, utilizing data retrieved from PubMed. The publishing trends indicate a growing research interest in the field over time, with notable peaks and declines. Coauthorship analyses of authors and institutions illuminated collaborative networks within the research community. Two departments at Ahvaz Jundishapur University of Medical Sciences in Iran, namely the Department of Periodontology within the School of Dentistry and the Diabetes Research Center within the Health Research Institute, demonstrated the highest total link strength. The co-occurrence analysis of keywords also unveiled thematic clusters, reflecting research focus areas and evolving trends. The analysis of topic trends highlighted persistent research interests in topics, such as type 2 diabetes mellitus, glycated hemoglobin, periodontitis, and therapy for chronic periodontitis, with shifts in therapeutic modalities investigated. The thematic map suggests that dental implants and tumor necrosis factor-alpha are emerging terms in the field that have gained more traction recently. Furthermore, the analysis of scientific production by country indicated varied contributions, with Brazil leading in publication output. Analysis of collaboration among corresponding authors' countries identified Italy exhibiting substantial international collaboration, while most of the countries primarily produced single-country publications. This comprehensive analysis provides insights into the multifaceted landscape of research on diabetes and oral health, emphasizing ongoing efforts to understand and address the complex interplay between these conditions.

Periodontitis and implant complications in diabetes

Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.

Are Inflamed Periodontal Tissues Endogenous Source of Advanced Glycation End-Products (AGEs) in Individuals with and without Diabetes Mellitus? A Systematic Review

Advanced glycation end-products (AGEs) are heterogeneous compounds formed when excess sugars condense with the amino groups of nucleic acids and proteins. Increased AGEs are associated with insulin resistance and poor glycemic control. Recently, inflamed periodontal tissues and certain oral bacteria were observed to increase the local and systemic AGE levels in both normoglycemic and hyperglycemic individuals. Although hyperglycemia induced AGE and its effect on the periodontal tissues is known, periodontitis as an endogenous source of AGE formation is not well explored. Hence, this systematic review is aimed to explore, for the first time, whether inflamed periodontal tissues and periodontal pathogens have the capacity to modulate AGE levels in individuals with or without T2DM and how this affects the glycemic load. Six electronic databases were searched using the following keywords: (Periodontitis OR Periodontal disease OR Periodontal Inflammation) AND (Diabetes mellitus OR Hyperglycemia OR Insulin resistance) AND Advanced glycation end products. The results yielded 1140 articles, of which 13 articles were included for the review. The results showed that the mean AGE levels in gingival crevicular fluid was higher in individuals with diabetes mellitus and periodontitis (521.9 pg/mL) compared to healthy individuals with periodontitis (234.84 pg/mL). The serum AGE levels in normoglycemic subjects having periodontitis was higher compared to those without periodontitis (15.91 ng/mL vs. 6.60 ng/mL). Tannerella forsythia, a common gram-negative anaerobe periodontal pathogen in the oral biofilm, was observed to produce methylglyoxal (precursor of AGE) in the gingival tissues. Increased AGE deposition and activate of AGE receptors was noted in the presence of periodontitis in both normoglycemic and hyperglycemic individuals. Hence, it can be concluded that periodontitis can modulate the local and systemic levels of AGE levels even in absence of hyperglycemia. This explains the bidirectional relationship between periodontitis and development of prediabetes, incident diabetes, poor glycemic control, and insulin resistance.

Porphyromonas gingivalis induces entero-hepatic metabolic derangements with alteration of gut microbiota in a type 2 diabetes mouse model

Periodontal infection induces systemic inflammation; therefore, aggravating diabetes. Orally administered periodontal pathogens may directly alter the gut microbiota. We orally treated obese db/db diabetes mice using Porphyromonas gingivalis (Pg). We screened for Pg-specific peptides in the intestinal fecal specimens and examined whether Pg localization influenced the intestinal microbiota profile, in turn altering the levels of the gut metabolites. We evaluated whether the deterioration in fasting hyperglycemia was related to the changes in the intrahepatic glucose metabolism, using proteome and metabolome analyses. Oral Pg treatment aggravated both fasting and postprandial hyperglycemia (P < 0.05), with a significant (P < 0.01) increase in dental alveolar bone resorption. Pg-specific peptides were identified in fecal specimens following oral Pg treatment. The intestinal Pg profoundly altered the gut microbiome profiles at the phylum, family, and genus levels; Prevotella exhibited the largest increase in abundance. In addition, Pg-treatment significantly altered intestinal metabolite levels. Fasting hyperglycemia was associated with the increase in the levels of gluconeogenesis-related enzymes and metabolites without changes in the expression of proinflammatory cytokines and insulin resistance. Oral Pg administration induced gut microbiota changes, leading to entero-hepatic metabolic derangements, thus aggravating hyperglycemia in an obese type 2 diabetes mouse model.

Gingival Crevicular Blood as a Potential Screening Tool: A Cross Sectional Comparative Study

Background: Diabetes is known to be one of the major global epidemic diseases, significantly associated with mortality and morbidity worldwide, conferring a substantial burden to the health care system. The epidemiological transition of this chronic disease tends to worsen unless preventive health strategies are implemented. Appropriate screening devices and standardized methods are crucial to prevent this potentially inauspicious life condition. Currently, the glucometer is the conventional device employed for blood glucose level determination that outputs the blood glucose reading. Glucometer performed in the dental office may be an important device in screening diabetes, so it can be addressed during a periodontal examination. Because gingival blood is a useful source to detect the glucose level, the focus is placed on the opportunity that might provide valuable diagnostic information. This study aimed to compare gingival crevicular blood with finger-stick blood glucose measurements using a self-monitoring glucometer, to evaluate whether gingival crevicular blood could be an alternative to allow accurate chairside glucose testing. Methods: A cross-sectional comparative study was performed among a 31–67-year-old population. Seventy participants with diagnosed type 2 diabetes and seventy healthy subjects, all with positive bleeding on probing, were enrolled. The gingival crevicular blood was collected using a glucometer to estimate the blood glucose level and compared with finger-stick blood glucose level. Results: The mean capillary blood glucose and gingival crevicular blood levels from all samples were, respectively, 160.42 ± 31.31 mg/dL and 161.64 ± 31.56 mg/dL for diabetic participants and 93.51 ± 10.35 mg/dL and 94.47 ± 9.91 mg/dL for healthy patients. In both groups, the difference between gingival crevicular blood and capillary blood glucose levels was non-significant (P < 0.05). The highly significant correlation between capillary blood glucose and gingival crevicular blood (r = 0.9834 for diabetic patients and r = 0.8153 for healthy participants) in both the groups was found. Conclusions: Gingival crevicular blood test was demonstrated as a feasible and useful primary screening tool test for detecting diabetes and for glucose estimation in non-diabetic patients. Use of gingival crevicular blood for screening is an attractive way of identifying a reasonable option of finger-stick blood glucose measurement under the appropriate circumstances. Rapid assessment may precede diagnostic evaluation in diabetic as well as healthy patients with acute severe bleeding. In addition, gingival crevicular blood levels may be needed to monitor the diabetic output.

Diabetes as a risk factor for periodontal disease-plausible mechanisms

The present narrative review examines the scientific evidence of the biological mechanisms that may link periodontitis and diabetes, as a source of comorbidity. Publications regarding periodontitis and diabetes, in human, animals, and in vitro were screened for their relevance. Periodontal microbiome studies indicate a possible association between altered glucose metabolism in prediabetes and diabetes and changes in the periodontal microbiome. Coinciding with this, hyperglycemia enhances expression of pathogen receptors, which enhance host response to the dysbiotic microbiome. Hyperglycemia also promotes pro-inflammatory response independently or via the advanced glycation end product/receptor for advanced glycation end product pathway. These processes excite cellular tissue destruction functions, which further enhance pro-inflammatory cytokines expression and alteration in the RANKL/osteoprotegerin ratio, promoting formation and activation of osteoclasts. The evidence supports the role of several pathogenic mechanisms in the path of true causal comorbidity between poorly controlled diabetes and periodontitis. However, further research is needed to better understand these mechanisms and to explore other mechanisms.

MMP-2 salivary activity in type 2 diabetes mellitus patients

BACKGROUND

Type 2 diabetes mellitus (T2DM) and periodontitis are chronic inflammatory diseases with a bidirectional relationship. The uncontrolled levels of glucose in T2DM patients change the pathophysiology and balance of inflammatory mediators. Matrix Metalloproteinase-2 (MMP-2) is a zinc-dependent endopeptidase that is responsible for tissue remodeling and degradation of the extracellular matrix in periodontal tissue. Therefore, the uncontrolled levels of glucose in T2DM could lead to an imbalance in MMP-2 activity in saliva, favoring the development of periodontitis.

METHODS

Ninety-seven T2DM patients from Hospital Dr. Donato Alarcon were included in the study. Following clinical examination, the patients were classified into four groups according to the presence and degree of periodontal disease and glycemic control. Blood and whole saliva samples (WSS) were collected from each patient. Blood samples were used for Hba1c and polymorphonuclear cells count determination, while WSS were used to determine MMP-2 activity, TIMP-1 and nitrite. MMP-2 activity was determined by zymography. TIMP-1 were determined by Western blotting, and nitric oxide (NO) levels were determined by the Griess method.

RESULTS

Of the 97 patients with T2DM, 66 had periodontitis of different severities: 18 patients had mild periodontitis, 15 had moderate and 33 had severe. Salivary MMP-2 activity, HbA1c and TIMP-1 were positively correlated with the severity of periodontitis. On the other hand, the increase in HbA1c was negatively correlated with MMP-2 activity and quantity of TIMP-1 but was positively correlated with nitrite levels.

CONCLUSIONS

T2DM with glycemic uncontrol conditions, distinct clinical alterations in periodontal tissue were identified, including a decrease in the gingival redness, increased the clinical attachment loss and imbalance of MMP-2/TIMP-1, as the possible causes of disorders promoting the progression of periodontitis. Accelerated periodontitis development with poor glycemic uncontrol likely results from the altered response of host defenses and decreased activity of polymorphonuclear cells. Taken together, these findings identify MMP-2 as a promising molecular market for periodontitis.

Subgingival Microbiota of Mexicans with Type 2 Diabetes with Different Periodontal and Metabolic Conditions

BACKGROUND

Type-2-Diabetes (T2D) and Periodontitis are major inflammatory diseases. However, not much is known about the specific subgingival microbiota in Mexicans with diabetes and metabolic dysbiosis. The aim of this study was to describe the subgingival microbiota of Mexicans with T2D and the different periodontal and metabolic conditions, through "Checkerboard" DNA-DNA hybridization.

METHODS

Subjects were divided into two groups-periodontal-health (PH) (PH_non-T2D; n = 59, PH_T2D; n = 14) and generalized-periodontitis (GP) (GP_non-T2D; n = 67, GP_T2D; n = 38). Obesity (BMI ≥ 30 kg/m2) and serum levels of glycated-hemoglobin (HbA1c), total-lipids, triglycerides, total-cholesterol, high-density-lipids, and low-density-lipids were measured for the T2D individuals. Subgingival microbial identification was processed for 40 species through DNA-probes.

RESULTS

Subjects with T2D harbored significantly higher mean total levels (PH: p < 0.001, and GP_NS), a lower proportion of "red" complex (GP: p < 0.01), a higher proportion of "yellow" (GP; p < 0.001), and "orange" (GP; p < 0.01) complex than the non-T2D. GP_T2D individuals exhibited a greater proportion of putative-species-Campylobacter gracilis and S. constellatus (p < 0.001), and Parvimonas micra and Prevotella nigrescens (p < 0.01), than GP_non-T2D. T2D individuals with HbA1c > 8% had presented significantly higher mean pocket-depth and higher levels of G. morbillorum (p < 0.05) and those with obesity or dyslipidemia harbored higher levels, prevalence, or proportion of Streptococcus sp., Actinomyces sp., and Capnocytophaga sp.

CONCLUSIONS

T2D individuals harbored a particular microbial profile different to non-T2D microbiota. Metabolic control was related to dysbiosis of microbiota-HbA1c>8% related to periodontitis and obesity or dyslipidemia with the predominance of saccharolytic bacteria, irrespective of their periodontal condition.

Diabetes mellitus and periodontal disease: awareness and practice among doctors working in public general out-patient clinics in Kowloon West Cluster of Hong Kong

BACKGROUND

Diabetes mellitus (DM) and periodontitis are very common and they interact with each other bidirectionally. This survey studied public primary care doctors on their awareness of this bidirectional relationship and their corresponding practice.

METHODS

All Family Medicine doctors in Kowloon West Cluster, Hospital Authority were invited to a cross-sectional questionnaire survey. Results were analyzed statistically.

RESULTS

One hundred sixty-eight questionnaires were sent out, 143 were returned (response rate 85.1%). One hundred forty valid questionnaires were analyzed. Ninety-two percent of participants were aware of a relationship between DM and periodontal disease and this awareness was not associated with their years of experience, training status and personal oral health behavior. Ninety percent knew the effect of poor DM control on periodontal disease but only 76% were aware of the reverse effect of periodontal disease on DM. The difference was statistically significant (p = 0.002, Related-samples Sign Test). In clinical practice on DM patients, only 5.7% asked dental history often (defined as 50% patients or above), 7.1% examined their mouths often and 12.1% recommended them to see dentist often. Logistic regression showed that awareness factors had no association with periodontology related clinical practice whereas clinical experience, being a Family Medicine specialist and personal interdental cleaning habit were linked with more positive practice.

CONCLUSIONS

A high proportion of doctors in the study were aware of the relationship between DM and periodontal disease. However, this did not appear to influence their practice. Further measures among doctors and patients to promote comprehensive management of DM and periodontal disease should be explored.

Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health

Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.

Serum lipid levels in patients with periodontal disease: A meta-analysis and meta-regression

AIM

Several papers have considered the potential relationship between periodontitis and lipid parameters. The present systematic review, meta-analysis and meta-regression studies focused on investigating whether serum lipid parameter levels were elevated in patients with periodontal disease (PD; without altered systemic conditions) in comparison with periodontally healthy subjects.

MATERIALS AND METHODS

Eligible studies were those with data about serum lipid parameter levels in non-smoking subjects with and without chronic periodontitis, who are generally healthy and not taking any medication for dyslipidaemia. Mean differences and 95% confidence intervals for total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol were obtained from all the selected studies.

RESULTS

A total of 19 publications were included for meta-analysis. Participants with chronic periodontitis presented significantly higher serum levels of LDL and triglycerides (p = .003 and p < .0001, respectively). The total cholesterol was higher in the PD group, but without significant difference in comparison with healthy participants. Significantly (p = .0005) lower HDL serum levels were found in patients with chronic periodontitis than in healthy subjects.

CONCLUSIONS

Even considering the limitations of this meta-analysis, it is suggested that PD is significantly associated with reduction in HDL and elevation of LDL and triglyceride concentrations. This analysis supports the rationale that periodontal disease is associated with lipid metabolic control.

Expression Profile of Genes Potentially Associated with Adequate Glycemic Control in Patients with Type 2 Diabetes Mellitus

Despite increasing research in type 2 diabetes mellitus (T2D), there are few studies showing the impact of the poor glycemic control on biological processes occurring in T2D. In order to identify potential genes related to poorly/well-controlled patients with T2D, our strategy of investigation included a primary screen by microarray (Human Genome U133) in a small group of individuals followed by an independent validation in a greater group using RT-qPCR. Ninety patients were divided as follows: poorly controlled T2D (G1), well-controlled T2D (G2), and normoglycemic individuals (G3). After using affy package in R, differentially expressed genes (DEGs) were prospected as candidate genes potentially relevant for the glycemic control in T2D patients. After validation by RT-qPCR, the obtained DEGs were as follows-G1 + G2 versus G3: HLA-DQA1, SOS1, and BRCA2; G2 versus G1: ENO2, VAMP2, CCND3, CEBPD, LGALS12, AGBL5, MAP2K5, and PPAP2B; G2 versus G3: HLA-DQB1, MCM4, and SEC13; and G1 versus G3: PPIC. This demonstrated a systemic exacerbation of the gene expression related to immune response in T2D patients. Moreover, genes related to lipid metabolisms and DNA replication/repair were influenced by the glycemic control. In conclusion, this study pointed out candidate genes potentially associated with adequate glycemic control in T2D patients, contributing to the knowledge of how the glycemic control could systemically influence gene expression.

The clinical and metabolic effects of subgingival application of xanthan-based chlorhexidine gel in Type 2 diabetic patients with chronic periodontitis

Background:

There is a two-way relationship between periodontal disease and diabetes. The purpose of this study was to evaluate the clinical and metabolic effects of a xanthan-based chlorhexidine (CHX) gel used as an adjunct to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis.

Materials and Methods:

Sixty-eight diabetic patients with moderate to advanced periodontitis and glycated hemoglobin (HbA1c) ≥6% were selected. The test group (n = 34) received scaling and root planning (SRP) plus xanthan-based CHX gel. The control group (n = 34) received single SRP. Fasting blood sugar (FBS) and HbA1c tests were done at the baseline and after 3 and 6 months. Data from the study were analyzed using descriptive statistics (mean ± standard deviation and frequency), ANOVA test by SPSS.15 software (SPSS Inc. Chicago, IL, USA). P < 0.05 was considered statistically significant.

Results:

Patients in test group exhibited a decrease in FBS from the baseline (227 ± 64.97) to the 3 and 6 months follow-up (208 ± 61.95 and 201 ± 61.33; P < 0.001). HbA1cb levels decreased from 7.72 ± 0.99 to 6.20 ± 0.97 and 6.06 ± 1.04 after 3 and 6 months follow-up (P < 0.001), respectively. Reduction of FBS and HbA1c was statistically significant after 3 and 6 months in the control group (P < 0.001).

Conclusion:

Considering the limitations of this study, the application of CHX gel might improve the effects of nonsurgical periodontal treatment in diabetic patients with periodontitis.

Relationship between Metabolic Syndrome and Number of Teeth in Japan

The 2004 Japanese National Health and Nutrition Survey collected data on several measures, including self-reported dental health. In addition, this was the first nationwide survey to focus on metabolic syndrome (MetS) in Japan. Therefore, the authors used this nationwide data set to assess the relationship between number of teeth present and MetS. Anonymized data were available with permission from the Ministry of Health, Labour and Welfare of Japan. Data from 3,195 men and women aged 35 to 99 y were examined, and logistic regression analyses were used to evaluate the association between number of teeth and MetS. Moreover, the authors performed an analysis of covariance to compare the mean number of teeth between those with and those without MetS, after adjusting for confounders. In comparison with those having ≥28 teeth, those with fewer remaining teeth demonstrated significantly higher odds of having MetS. Specifically, those having 1 to 9 teeth had higher odds of having MetS than those with more teeth and were more than twice as likely to be affected than those with ≥28 teeth. Furthermore, individuals with MetS in the age groups of 45 to 54, 55 to 64, and 65 to 74 y had significantly fewer teeth than those without MetS in the same age groups. These results suggest that the number of teeth present is associated with the prevalence of MetS in the Japanese population. Knowledge Transfer Statement: The results of this study can be used by clinicians when they examine patients with periodontal disease or extensive tooth loss to refer for a general medical examination.

A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes

AIMS

To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered.

METHODS

Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review.

RESULTS

Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1β, TNF-α, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetes-associated periodontitis. A role for locally activated pro-inflammatory factors in the periodontium, which subsequently impact on diabetes, remains speculative.

CONCLUSION

There is substantial information on potential mechanistic pathways which support a close association between diabetes and periodontitis, but there is a real need for longitudinal clinical studies using larger patient groups, integrated with studies of animal models and cells/tissues in vitro.

Effectiveness of glucometer in screening diabetes mellitus using gingival crevicular blood

AIM

Study was carried out to evaluate the efficacy of a glucometer for screening diabetes using gingival crevicular blood and to compare the blood glucose levels in the gingival crevicular blood sample and blood sample collected by finger puncture method using glucometers.

SUBJECTS AND METHODS

A total of 24 known diabetic patients who fulfilled the selection criteria were selected after obtaining their informed consent. Samples were collected from two sites, i.e., gingival crevice and fingertip which was measured using a self-monitoring device.

STATISTICAL ANALYSIS USED

Karl Pearson correlation.

RESULTS

This study revealed the existence of a positive correlation between gingival crevicular blood and capillary blood glucose level (r = 0.826), and gingival blood glucose level estimates 68.2% of capillary blood glucose level. Hence, based on the observations of the study using gingival crevicular blood glucose level, capillary blood glucose level may be estimated based on the following regression equation. Capillary blood glucose = 84.66 + 0.77x gingival crevicular blood glucose level.

CONCLUSIONS

The intraoral sampling technique is safer, convenient, and cost-effective for the dental practitioner as the sample can be obtained during the routine periodontal examination. It can be concluded that with the regression equation based on the gingival crevicular blood glucose level, capillary blood glucose can be estimated.

The influence of type 2 diabetes mellitus on salivary matrix metalloproteinase-8 levels and periodontal parameters: A study in an Indian population

OBJECTIVE

Although many studies reported more severe periodontal disease and the existing proinflammatory conditions in patients with diabetes but only few have examined the effect of type 2 diabetes mellitus (DM) on salivary matrix metalloproteinase-8 (MMP-8) level and other periodontal parameters. This study aims to evaluate the effect of type 2 DM on salivary MMP-8 levels and periodontal parameters, which might be useful in monitoring periodontal disease in diabetes.

MATERIALS AND METHODS

A total of 90 subjects were selected for the study and were divided into three groups: Group I included 30 healthy subjects; Group II included 30 subjects without type 2 DM but with chronic periodontitis, and Group III included 30 subjects with type 2 DM and chronic periodontitis. Periodontal parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were taken. The salivary MMP-8 level was estimated by Quantikine Human total MMP-8 immunoassay kit using ELISA method.

RESULTS

The mean value of the salivary MMP-8 of Group III was highest followed by Group II and Group I, the least. The other periodontal parameters PI, GI, PPD, CAL, was comparatively highest for Group III.

CONCLUSION

This study suggests that diabetes is associated with an increased prevalence, extent, and severity of periodontitis. Furthermore, the increased levels of MMP-8 indicate the influence of diabetes on their salivary concentration.

Diabetes as a risk factor for medication-related osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw (MRONJ) is a severe devastating complication for which the exact pathogenesis is not completely understood. Multiple systemic and local factors may contribute to the development of MRONJ. A growing body of evidence supports diabetes mellitus (DM) as an important risk factor for this complication; however, the exact mechanism by which DM may promote MRONJ has yet to be determined. The current review elucidates the role of DM in the pathogenesis of MRONJ and the mechanisms by which DM may increase the risk for MRONJ. Factors related to DM pathogenesis and treatment may contribute to poor bone quality through multiple damaged pathways, including microvascular ischemia, endothelial cell dysfunction, reduced remodeling of bone, and increased apoptosis of osteoblasts and osteocytes. In addition, DM induces changes in immune cell function and promotes inflammation. This increases the risk for chronic infection in the settings of cancer and its treatment, as well as antiresorptive medication exposure, thus raising the risk of developing MRONJ. A genetic predisposition for MRONJ, coupled with CYP 450 gene alterations, has been suggested to affect the degradation of medications for DM such as thiazolidinediones and may further increase the risk for MRONJ.

Advanced glycation end products upregulate the endoplasmic reticulum stress in human periodontal ligament cells

BACKGROUND

The accumulation of advanced glycation end products (AGEs) appears to be the main factor responsible for modulating periodontal inflammation in diabetes. The aim of this study is to examine the effects of AGEs on inflammation in human periodontal ligament cells and to investigate the mechanism with a specific emphasis on the role of endoplasmic reticulum (ER) stress-induced nuclear factor-kappa B (NF-κB) pathway.

METHODS

Cytotoxicity was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The protein expressions of ER markers and NF-κB were examined by Western blot analysis. The translocation of NF-κB was observed by immunofluorescence assay. Proinflammatory chemokine production was determined by enzyme-linked immunosorbent assay.

RESULTS

Treatment with AGEs reduced cell viability in a concentration- and time-dependent manner. AGEs induced ER stress, as evidenced by survival molecules, such as glucose-regulated protein 78 (GRP78), double-stranded RNA-activated protein kinase-like ER kinase (PERK), and activating transcription factor 6 (ATF-6), and apoptotic molecules, such as CCAAT/enhancer binding protein homologous protein (CHOP) and caspase 12. AGEs upregulated the nucleoprotein expression of NF-κB, enhanced translocation of NF-κB from the cytoplasm to the nucleus, and increased the production of proinflammatory chemokines interleukin-6 and interleukin-8.

CONCLUSION

AGEs mediate inflammation of human periodontal ligament cells via the ER stress-induced NF-κB pathway.

Self-perceived oral health and periodontal parameters in chronic periodontitis patients with and without rheumatoid arthritis

AIM

It is hypothesized that self-perceived oral health and periodontal status are worse in chronic periodontitis (CP) patients with rheumatoid arthritis (RA) compared to CP patients without RA. The aim of the present study was to assess self-perceived oral health and periodontal parameters in CP patients with and without RA.

METHODS

Fifty CP patients with RA and 50 CP patients without RA were included. Information regarding sociodemographic characteristics and self-perceived oral symptoms were collected using a questionnaire. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, number of missing teeth, and marginal bone loss) were recorded.

RESULTS

There was no significant difference in socioeconomic status, education status, self-perceived oral symptoms, and periodontal parameters among CP patients with and without RA.

CONCLUSIONS

Self-perceived oral health and periodontal parameters are mainly governed by the intensity of CP, and the role of RA in this context seems to be rather secondary.

Cytokines in patients with type 2 diabetes and chronic periodontitis: A systematic review and meta-analysis

Individuals with type 2 diabetes mellitus (T2DM) and chronic periodontitis have significantly higher levels of interleukin-1 beta compared with systemically healthy individuals with chronic periodontitis. However, there was no significant difference in gingival crevicular levels of other cytokines between individuals with and without T2DM.

Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review

BACKGROUND

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia. The abnormal glucose metabolism results from defects in insulin production or insulin action, or both. For decades, it was suspected that diabetes contributed to poorer oral health and the increased frequency of periodontitis. More recently it was found that periodontitis could adversely affect glycemic control in diabetics. This review focuses on the bidirectional relationship between diabetes mellitus and periodontitis.

METHODS AND RESULTS

A review of the literature on periodontal disease in diabetes using the following key words: periodontitis/periodontal disease and diabetes mellitus, hyperglycemia/glycemic control.

CONCLUSIONS

There is strong evidence for an association between diabetes mellitus and inflammatory periodontal disease. Diabetes mellitus increases the risk for and severity of periodontitis, and periodontal diseases can aggravate insulin resistance and affect glycemic control. Periodontal treatment improves glycemic control in type 2 diabetics; control of periodontal infection is not only important for oral health, it may also improve overall health.

Diabetes mellitus and periodontal diseases

A bidirectional relationship between diabetes mellitus (DM) and periodontal diseases (PDs) has been established. It is estimated that patients with poorly controlled DM are 3 times more likely to develop chronic PD compared with normoglycemic individuals despite similar composition in subgingival biofilms. Furthermore, these patients present with increased severity and rapid progression of attachment loss around teeth resulting in edentulism. Treatment of PD results in a modest but significant improvement in glycemic control in patients with DM reflected by a 0.4 % reduction in HbA1c-glycated hemoglobin levels. Compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the 2 conditions centered on systemic low-grade inflammation. However, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for DM and PD regarding the management of the 2 diseases in an individual.

Molecular mechanisms involved in the bidirectional relationship between diabetes mellitus and periodontal disease

Both diabetes and periodontitis are chronic diseases. Diabetes has many adverse effects on the periodontium, and conversely periodontitis may have deleterious effects further aggravating the condition in diabetics. The potential common pathophysiologic pathways include those associated with inflammation, altered host responses, altered tissue homeostasis, and insulin resistance. This review examines the relationship that exists between periodontal diseases and diabetes mellitus with a focus on potential common pathophysiologic mechanisms.

Clinical review: Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

BACKGROUND

Several epidemiological studies have reported an association between metabolic syndrome (MetS) and periodontal diseases (PDs). The aim of this systematic review was to investigate the existence and magnitude of this association.

MATERIALS AND METHODS

A systematic search of the literature was conducted looking for case-control, cross-sectional, cohort studies and population surveys including patients with measures of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane library databases were used for the search by 2 independent reviewers. A meta-analysis was conducted to investigate the association for coexistence of MetS and PD.

RESULTS

A total of 20 studies were included in the review, from an initial search of 3486 titles. Only 1 study reported longitudinal data on the onset of MetS components in association with periodontal measures. However, several studies investigated coexistence. A random effects meta-analysis showed that the presence of MetS is associated with the presence of periodontitis in a total of 36 337 subjects (odds ratio = 1.71; 95% confidence interval = 1.42 to 2.03). When only studies with "secure" diagnoses were included (n = 16 405), the magnitude of association increased (odds ratio = 2.09; 95% confidence interval = 1.28 to 3.44). Moderate heterogeneity was detected (I(2) = 53.6%; P = .004).

CONCLUSIONS

This review presents clear evidence for an association between MetS and periodontitis. The direction of the association and factors influencing it should be investigated by longitudinal and treatment studies. Periodontal diagnostic procedures should be routinely carried out in MetS patients.

Lipid profile of people with diabetes mellitus type 2 and periodontal disease

The objective of this study was to evaluate improvement of lipids and periodontal disease in patients with type 2 Diabetes mellitus, by means of the relationship between blood levels of total cholesterol and its fractions, triglycerides and clinical periodontal parameters. Twenty patients, in age-range 18-70 years, were selected and divided into 2 groups: (1) conventional periodontal scaling and root planing+controlled mechanic; (2) conventional periodontal scaling and root planing+controlled mechanical+maintenance therapy. The analyses were performed on day 0, 180 and 720 days, including plaque index, gingival index, probing depth and clinical attachment level, and evaluation of total cholesterol and its fractions, and triglycerides. The 2 groups presented significant reduction in clinical periodontal parameters, however, probing depth did not diminish significantly only in Group 1. There was significant improvement in all blood parameters in both groups. It was concluded that after 720 days of the experiment, there were significant improvements in clinical and blood parameters, in general. The group that received maintenance therapy also showed a more expressive improvement in clinical periodontal parameters, in general, suggesting that this therapy is important and necessary in patients with type 2 Diabetes mellitus and periodontal disease.

Effect of locally delivered tetracycline hydrochloride as an adjunct to scaling and root planing on Hba1c, C-reactive protein, and lipid profile in type 2 diabetes: A clinico-biochemical study

AIM

The aim was to assess the levels of HbA1c, C-reactive protein, and lipid profile in patients with type 2 diabetes mellitus by treating the pockets using collagen impregnated sustained release resorbable tetracycline fiber (periodontal plus AB fiber) following scaling and root planing (SRP).

MATERIALS AND METHODS

A total of 40 patients with type 2 diabetes mellitus were randomly distributed into two groups receiving either SRP and tetracycline fiber or SRP alone. Patients were evaluated clinically with gingival index, plaque index, probing depth, and relative attachment level, and bio-chemically with HbA1c, C Reactive Protein, and lipid profile at baseline, 1 month, and 3 months.

RESULTS

Significant reduction in all the clinical parameters was seen in the tetracycline group compared to the control group. Bio-chemical analysis also revealed similar results except for cholesterol and High density lipoprotein who did not show any significant reduction.

CONCLUSION

Locally delivered tetracycline as a better treatment modality compared to SRP alone.

Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial

BACKGROUND

Periodontal diseases and diabetes are two common diseases with high prevalence. Many clinicians have accepted the relationship between these two diseases. Some investigators have reported that periodontal treatment may enhance the metabolic control of diabetes. The effects of non-surgical periodontal treatment on metabolic control in people with type 2 diabetes mellitus (DM2) were examined.

METHODS

Forty patients with DM2 and chronic periodontitis [mean age = 50.29 years; mean glycated haemoglobin (HbA1c) = 8.72] were randomly assigned to two groups. The treatment group (n = 22) received full-mouth scaling and root planing, whereas the control group (n = 18) received no periodontal treatment. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), triglyceride (TG) and cholesterol levels were recorded at baseline and compared to data collected three months later.

RESULTS

The groups did not differ in gender ratio, age or clinical parameters [PPD (p = 0.107), CAL (p = 0.888), PI (p = 0.180)] and biochemical markers at baseline [FPG (p = 0.429), HbA1c (p = 0.304), TG (p = 0.486), TC (p = 0.942), LDL (p = 0.856) and HDL (p = 0.881)]. FPG, HbA1c and clinical parameters differed between the treatment and control groups (p = 0.006, 0.003 and 0, respectively). From baseline to follow-up (after three months), HbA1c levels decreased in the treated group (p = 0.003). In the same time period, FPG, GI, PPD and CAL increased in the control group (p = 0.016, 0.0, 0.0 and 0.004, respectively) but HbA1c did not change significantly.

CONCLUSIONS

Non-surgical periodontal therapy could improve metabolic control in diabetic patients.

Cytokine profile in the gingival crevicular fluid of periodontitis patients with and without type 2 diabetes: a literature review

BACKGROUND

Periodontitis may occur in patients with and without type 2 diabetes (T2D). It may be hypothesized that the gingival crevicular fluid (GCF) cytokine profile in patients with periodontitis with poorly controlled T2D may differ from the GCF cytokine profile in medically healthy individuals with periodontitis. The aim was to review the cytokine profiles in the GCF of patients with periodontitis with and without T2D.

METHODS

Databases were searched from 1988 to August 2011 using different combinations of various keywords. Titles and abstracts of articles that satisfied the eligibility criteria were screened by the authors and checked for agreement. Only articles published in English were included.

RESULTS

Ten studies were included. Two studies reported GCF concentrations of interleukin (IL)-6 to be higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. Two studies showed GCF IL-6 levels to be higher in periodontitis with T2D compared to medically healthy subjects without periodontitis. In one study GCF levels of IL-17, IL-23, and interferon-γ were higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. In one study, GCF concentrations of IL-8 were significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Three studies reported GCF levels of IL-1α to be significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis.

CONCLUSION

The GCF cytokine profile in patients with and without T2D seems to be governed by the intensity of periodontal inflammation and the role of T2D in this regard is rather secondary.

Elevated plasma homocysteine levels in chronic periodontitis: a hospital-based case-control study

BACKGROUND

Plasma homocysteine (Hcy), a novel risk factor for cardiovascular disease, has been found to be increased in inflammatory diseases, such as rheumatoid arthritis. Our study investigates the association between chronic periodontitis and plasma Hcy.

METHODS

This case-control study involves 85 age- and sex-matched subjects with chronic periodontitis and 91 healthy controls. Patients were grouped into moderate and severe periodontitis. Plaque index, calculus component of simplified oral hygiene index, and modified gingival index were recorded. Body mass index, fasting blood sugar, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, and plasma Hcy were also assessed.

RESULTS

Case and control groups had similar levels of fasting blood sugar, lipid profile, and body mass index. The mean plasma Hcy was found to be 19.22 ± 8.27 and 10.27 ± 2.50 μmol/L for cases and controls, respectively. A significant elevation in plasma Hcy levels was observed in cases (P <0.05). No significant differences were observed in plasma Hcy levels between moderate and severe chronic periodontitis (P = 0.722).

CONCLUSIONS

Elevated levels of plasma Hcy were observed in patients with chronic periodontitis. Future research should be directed on the effect of periodontal therapy on plasma Hcy levels.

Alterations of Serum Lipid and Inflammatory Cytokine Profiles in Patients with Coronary Heart Disease and Chronic Periodontitis: A Pilot Study

Serum lipid and inflammatory cytokine profiles were assessed in 124 in-patients with coronary heart disease (CHD) (CHD group) and 43 inpatients with no evidence of CHD (control group). In all patients, research questionnaires and examinations of periodontal health were conducted and venous blood samples were analysed. Both groups were divided into two subgroups according to the presence or absence of chronic periodontitis in individual patients. The prevalence of chronic periodontitis was higher in patients from the CHD group than in the control group. Levels of total cholesterol, triglycerides, low-density lipoprotein, oxidized low-density lipoprotein, high-sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-a were significantly higher in CHD patients with chronic periodontitis than in those without periodontitis. In conclusion, chronic periodontitis may be associated with CHD.

Cross-sectional study of periodontal care and Glycosylated Hemoglobin in an insured population

OBJECTIVE

Compare GHb among people with diabetes who have and have not received periodontal care.

RESEARCH DESIGN AND METHODS

This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40-70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the association between GHb and periodontal treatment intensity. We determined associations using linear regression adjusted for potential confounders and tested for effect modification by age, sex, insulin use, diabetes severity, BMI, and smoking.

RESULTS

Mean GHb was 7.66%; 38% of participants received periodontal care during the 5 years. After multivariate adjustment, patients who received periodontal care had a GHb level 0.08 percentage points higher than patients who did not (P = 0.02). In stratified analyses, the association was present for women (0.18 percentage points higher GHb with periodontal care, P < 0.001) but not significant for men (0.008 percentage points lower, P = 0.86). In patients who received periodontal care, those with one, and with two or more, surgical treatments had GHb 0.25 (P = 0.04) and 0.36 (P = 0.002) percentage points lower, respectively, than patients without periodontal surgeries.

CONCLUSIONS

This population-based cross-sectional study showed small associations between periodontal care (a proxy for periodontitis) and higher GHb. Well-controlled longitudinal studies or clinical trials are needed to evaluate causality and temporal trends. Sub-analyses suggest that further investigation of this association among women, and by intensity of periodontal treatment, may be of interest.

[Pathogenesis of parodontitis in rheumatic diseases]

Inflammatory periodontal disease (PD) is a common disease worldwide that has a primarily bacterial aetiology and is characterized by dysregulation of the host inflammatory response. The degree of inflammation varies among individuals with PD independently of the degree of bacterial infection, suggesting that alteration of the immune function may substantially contribute to its extent. Factors such as smoking, education, and body mass index (BMI) are discussed as potential risk factors for PD. Most PD patients respond to bacterial invaders by mobilizing their defensive cells and releasing cytokines such as interleukin (IL)-1beta, tumour necrosis factor (TNF)-alpha, and IL-6, which ultimately causes tissue destruction by stimulating the production of collagenolytic enzymes, such matrix metalloproteinases. Recently, there has been growing evidence suggesting an association between PD and the increased risk of systemic diseases, such ateriosclerosis, diabetes mellitus, stroke, and rheumatoid arthritis (RA). PD and rheumatologic diseases such as RA share many pathological aspects and immunological findings.

Proinflammatory gene expression at chronic periodontitis and peri-implantitis sites in patients with or without type 2 diabetes

BACKGROUND

Diabetes and periodontal diseases are often associated. Both have highly inflammatory components, but the role played by distinct phlogistic mediators in their pathogenesis is not fully understood and remains controversial. The purpose of this study is to evaluate whether type 2 diabetes alters the expression of inflammatory mediators in sites with chronic periodontitis (CP) or peri-implantitis (P-IM).

METHODS

The expression of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6 and -8, and monocyte chemotactic protein (MCP)-1 plus key CC chemokine receptors (CCR1 through 5) and CXC chemokine receptors (CXCR1 through 3) was quantified by real-time polymerase chain reaction (PCR) in gingival or peri-implant biopsies from 135 patients with well-controlled or poorly controlled diabetes and periodontal disease, 65 patients with periodontal disease but otherwise healthy, and 90 systematically and periodontally healthy subjects. Western blots were performed.

RESULTS

Relative to controls, in patients without diabetes and patients with well-controlled diabetes, TNF-alpha, CCR5, and CXCR3 expression was exclusively higher in sites with P-IM (P <0.01), whereas IL-6 and -8 were overexpressed in sites with CP and, even more, in sites with P-IM (P <0.01). In patients with poor glycemic control, TNF-alpha, CCR5, and CXCR3 mRNAs were increased in sites with CP (P <0.01). A statistically significant higher IL-6 and -8 expression from patients without diabetes and patients with well-controlled diabetes was observed compared to patients with poorly controlled diabetes. Regardless of metabolic/glycemic status, MCP-1 and CCR2 and 4 were markedly higher in both of the oral pathologies examined (P <0.01). At the protein levels, Western blot experiments confirmed the real-time PCR results.

CONCLUSIONS

These findings showed that: 1) in subjects without diabetes and patients with well-controlled diabetes, TNF-alpha, CCR5, and CXCR3 may constitute distinctive biomarkers of P-IM; 2) poor glycemic control abolished the differences between CP and P-IM regarding the expression of these mediators; and 3) type 2 diabetes affected the expression of TNF-alpha, IL-6 and -8, CCR5, and CXCR3.

Periodontal disease might be associated even with impaired fasting glucose

OBJECTIVE

To determine whether there is an association between fasting plasma glucose level and periodontal condition in a non-diabetic male population.

METHODS

Data of periodic medical examinations of 815 non-diabetic male adults (mean age 38.1 + or - 7.0 years) were analysed. Blood samples were drawn from each subject following a 14-hour fast. The distance between the cement-enamel-junction to alveolar bone crest was measured at inter-proximal sites on two standardised posterior bitewing radiographs.

RESULTS

Higher prevalence of alveolar bone loss was found among individuals with a fasting glucose level of > or = 100 mg/dL than among individuals with <100 mg/dL (p = 0.032) and among individuals with BMI > or = 25 than among individuals with BMI <25 (p = 0.025). Associations were found between bone loss prevalence and serum triglyceride levels of > or = 200mg/dL, total cholesterol level of > or = 200mg/dL and LDL-cholesterol level of > or = 130 mg/dL (p = 0.010, p <0.001, p = 0.009, respectively).

CONCLUSIONS

In the studied non-diabetic adult population, periodontal disease was associated with impaired glucose level. Periodontal disease could serve as a predictor for future diabetes mellitus, or play a possible role in the glucose imbalance and diabetes mellitus development.

Characteristics of inflammation common to both diabetes and periodontitis: are predictive diagnosis and targeted preventive measures possible?

Diabetes and periodontitis are chronic inflammatory disorders that contribute to each others' severity and worsen each others' prognosis. Studies have shown that patients with diabetes are at increased risk of developing periodontitis, and that diabetics with untreated periodontitis have more difficulty controlling serum glucose. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Periodontitis is accompanied by gingival bleeding and the production of an inflammatory exudate termed gingival crevicular fluid (GCF) that arises from the inflamed gingival tissues surrounding the teeth. GCF contains byproducts of connective tissue degradation, enzymes from host and bacterial cells, cytokines and other inflammatory mediators, and has been studied for screening blood glucose and for biomarkers of both diabetes and periodontitis. This review focuses on the inter-relationship between diabetes and periodontitis and the biomarkers common to both these diseases that may enable earlier detection, targeted preventive measures and individualized therapeutic intervention of these chronic conditions.

Metabolic syndrome and periodontitis: is oxidative stress a common link?

A review of pathological mechanisms that can explain the relationship between periodontitis and cardiovascular disease (CVD) is necessary to improve the management of both conditions. Metabolic syndrome is a combination of obesity, hypertension, impaired glucose tolerance or diabetes, hyperinsulinemia, and dyslipidemia. All these have been examined in recent years in terms of their relationship to periodontitis. Reviewed data indicate an association between some of them (body mass index, high-density lipoprotein-cholesterol [HDL-C], triglycerides, high blood pressure, among others) and periodontitis. Oxidative stress may act as a potential common link to explain relationships between each component of metabolic syndrome and periodontitis. Both conditions show increased serum levels of products derived from oxidative damage, with a pro-inflammatory state likely influencing each other bidirectionally. Adipocytokines might modulate the oxidant/anti-oxidant balance in this relationship.

Periodontal status in subjects with hyperlipidemia

BACKGROUND

Hyperlipidemia is a major risk factor for cardiovascular disease. Recent reports showed a possible association between periodontal disease and an increased risk for cardiovascular disease. The aim of this study was to evaluate whether hyperlipidemia has any influence on periodontal status.

METHODS

Fifty-one subjects with hyperlipidemia and 47 normolipidemic subjects participated in this study. Biochemical parameters, including plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels, and periodontal parameters, including plaque index (PI), probing depth (PD), clinical attachment level (CAL), and percentage of sites with bleeding on probing (BOP [%]), were evaluated.

RESULTS

The mean values of PI, PD, CAL, and BOP (%) for the hyperlipidemic group were significantly higher than those for the control group. Plasma triglyceride, total cholesterol, and LDL-C levels were significantly and positively associated with PI, PD, BOP (%), and CAL. HDL-C was significantly, but negatively, associated with CAL. Plasma triglyceride level was significantly associated with PD and BOP (%) after further analyses.

CONCLUSIONS

The results of our study showed that patients with mild or moderate hyperlipidemia manifested higher values of periodontal parameters compared to normolipidemic individuals. Further studies are needed to determine the effect of hyperlipidemia on periodontal disease.

Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E(2) among non-smoking subjects with gingivitis and type 2 diabetes

BACKGROUND

The goal of this study was to assess whether non-smoking patients with type 2 diabetes present with increased levels of local and systemic proinflammatory mediators and, if so, whether such an increase is associated with enhanced clinical gingival inflammation compared to non-smoking patients without diabetes.

METHODS

We used a cross-sectional database consisting of 725 self-reported lifelong non-smokers aged 53 to 74 years. Gingival crevicular fluid (GCF) levels of interleukin (IL)-1beta and prostaglandin E(2) (PGE(2)) and serum levels of IL-6 were measured using enzyme-linked immunosorbent assay. No participant had probing depth >3 mm. Participants with bleeding on probing (BOP) in <10% of sites were classified as healthy, whereas those with BOP in >or=10% of sites were defined as having biofilm-gingival interface (BGI) gingivitis.

RESULTS

Approximately 53% (n = 385) and 11% (n = 80) of the sample had BGI gingivitis and type 2 diabetes, respectively. The mean age-adjusted level of GCF IL-1beta was significantly elevated in the diabetic group compared to the non-diabetic group (P = 0.048), but serum IL-6 (P = 0.14) and GCF PGE(2) were not (P = 0.98). The mean GCF IL-1beta and PGE(2) levels were significantly elevated in subjects with BGI gingivitis (136.2 +/- 112.9 ng/ml and 277.2 +/- 187.2 ng/ml, respectively) compared to subjects with gingival health (95.9 +/- 82.9 ng/ml and 205.7 +/- 149.6 ng/ml, respectively), regardless of diabetic status (P <0.001 for both). However, serum IL-6 was elevated in subjects with BGI gingivitis compared to subjects with gingival health only among subjects with diabetes (2.9 +/- 3.2 pg/ml versus 1.5 +/- 1.4 pg/ml; P = 0.008). With the exception of serum IL-6 in subjects without diabetes, an increase in the levels of proinflammatory mediators was associated with increased odds of having BGI gingivitis. The associations were stronger in the diabetic group.

CONCLUSIONS

Type 2 diabetes may increase the host inflammatory response to oral biofilm, which, in turn, may exacerbate preconditions associated with gingivitis in susceptible individuals. Furthermore, systemic inflammation, as demonstrated by the increased level of serum IL-6, is associated with BGI gingivitis among non-smoking patients with diabetes.